Academic Editors: Marialuisa Zedde and Rosario Pascarella
Background: Real-world, observational studies have investigated the
safety profile of Direct Oral Anticoagulants (DOACs) on Major Hemorrhage (MH)
used for stroke prevention in Non-Valvular Atrial Fibrillation (NVAF). We
performed a systematic review and meta-analysis to investigate the comparative
safety of DOACs versus other DOACs and versus Vitamin K Antagonists (VKAs)
adhering to PRISMA guidelines. We defined MH according to the International
Society on Thrombosis and Haemostasis statement or as the composite outcome of
intracranial, gastrointestinal, genitourinary, respiratory, cavitary and
musculoskeletal bleeding in case of studies using International Statistical
Classification of Diseases codes for patient selection. Methods: We
systematically investigated two databases (Medline, Embase) until April of 2021,
gathered observational studies and extracted hazard ratios (HRs) with 95%
confidence intervals (CI) on our outcome of interest. Additional subgroup
analyses according to DOAC dosing, prior diagnosis of chronic kidney disease,
prior diagnosis of stroke, history of previous use of VKA, the users’ age, the
users’ gender and study population geographic region were conducted. All analyses
were performed with a random-effects model. Results: From this search,
55 studies were included and 76 comparisons were performed. The MH risk
associated with Rivaroxaban use was higher than the risk with Dabigatran use (HR:
1.32, 95% CI: 1.21–1.45, I